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PharmacoEconomics

, Volume 27, Issue 1, pp 55–68 | Cite as

Cost Effectiveness of High-Dose Chemotherapy with Autologous Stem Cell Support as Initial Treatment of Aggressive Non-Hodgkin’s Lymphoma

  • Philippe Fagnoni
  • Noel Milpied
  • Samuel Limat
  • Eric Deconinck
  • Virginie Nerich
  • Charles Foussard
  • Philippe Colombat
  • Jean-Luc Harousseau
  • Marie-Christine Woronoff-Lemsi
Original Research Article

Abstract

Background: The GOELAMS 072 study showed that first-line high-dose chemotherapy (HDT) with peripheral blood stem cell transplant (PBSCT) support was superior to the standard chemotherapy regimen (cyclophosphamide, doxorubicin, vincristine and prednisone; CHOP) in adults with aggressive non-Hodgkin’s lymphoma (NHL).

Objective: The aim of the study was to evaluate the pharmacoeconomic profile of HDT with PBSCT support relative to standard CHOP therapy as first-line treatment in adults with aggressive NHL.

Methods: We performed a cost-effectiveness analysis from the French Public Health Insurance perspective, restricted to hospital costs (€, year 2008 values). The clinical effectiveness criterion was censured overall survival (OS) difference after a median follow-up of 4 years for the entire cohort. A total of 197 patients were included (CHOP, n = 99; HDT, n = 98). Uncertainty was assessed using non-parametric bootstrap simulations and various scenario analyses.

Results: Five-year OS did not differ significantly between groups for the entire cohort. Nevertheless, subgroup analyses appeared to be more relevant for decision making: among patients with a high-intermediate risk according to the age-adjusted International Prognostic Index (IPI), HDT yielded a significantly higher 5-year OS than CHOP (74% vs 44%; p = 0.001). Among these patients, the mean censured OS survival, adjusted for time discounting and quality of life (QOL), increased with HDT by 1.20 years (95% CI 1.19, 1.21). The cost per life-year saved with HDT was estimated as h34 315 (95% CI 32 683, 35 947) in this subgroup.

Conclusion: Results suggested thatHDT with PBSCT supportmight be considered a cost-effective strategy among patients with high-intermediate-risk NHL according to the age-adjusted IPI. Its place and its cost effectiveness potential versus, or in combination with, rituximab still need further research.

Keywords

Overall Survival Peripheral Blood Stem Cell Transplant Autologous Bone Marrow Transplantation Unit Prex Chop Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

No sources of funding were used to assist in the preparation of this study. The authors have no conflicts of interest that are directly relevant to the content of this study.

The authors would like to thank Michel Lamure, Céline Menat, Fanny Gaillard, Vincent Delwail, Christian Berthou, Rémy Gressin, Jean-Yves Cahn and Virginie Lucas.

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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Philippe Fagnoni
    • 1
    • 2
  • Noel Milpied
    • 3
  • Samuel Limat
    • 1
    • 2
  • Eric Deconinck
    • 4
    • 5
  • Virginie Nerich
    • 1
    • 4
  • Charles Foussard
    • 6
  • Philippe Colombat
    • 7
  • Jean-Luc Harousseau
    • 8
  • Marie-Christine Woronoff-Lemsi
    • 1
    • 4
  1. 1.Department of PharmacyUniversity Hospital of BesançonBesançon CedexFrance
  2. 2.INSERM, EPI 106University of BourgogneDijonFrance
  3. 3.Department of HaematologyUniversity Hospital of BordeauxPessacFrance
  4. 4.INSERM, U 645 EA-2284 IFR-133University Franche-ComteBesançonFrance
  5. 5.Department of HaematologyUniversity Hospital of BesançonBesançonFrance
  6. 6.Department of HaematologyUniversity Hospital of AngersAngersFrance
  7. 7.Department of HaematologyUniversity Hospital of ToursToursFrance
  8. 8.Department of HaematologyUniversity Hospital of NantesNantesFrance

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